{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   W HUMPHRIES","gend":0,"add":"204 EDGEWOOD ROAD","city":"CHESAPEAKE","state":"VA","zip":23321,"dob":"2002-07-03","age":"","mstatus":"","insh":"8060797*01","cliId":"","pno":"757\/338-4621","cno":"757\/338-4621","email":"","ename":"","eno":"","pphy":"DORBAD, DAVID G MD","ppno":"757\/488-2223","pcpadd":"SUITE 200A 4012 RAINTREE ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":200329,"pcpname":"Renaissance Pediatrics","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0890","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","R51.","R11.10","C71.9","F43.21","F40.11","F90.0","R51.9","R93.0","Z98.890","C71.2","B34.9","S80.811A","M54.9","V43.62XA","Y92.488","Y93.89","F90.9","F43.23","F41.0","G43.001"],"date":["2021-03-02","2020-08-05","2020-07-24","2020-08-05","2020-08-05","2021-03-12","2021-03-12","2021-07-14","2021-07-14","2021-07-14","2020-07-30","2020-05-21","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-03-02","2021-03-02","2021-03-02","2020-08-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","51991036378","RIZATRIPTAN ","10MG ODT","12","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","10","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","14","Select","Select",""],["","54092038301","ADDERALL ","10MG","30","Select","Select",""],["","60505265401","TRAZODONE ","100MG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","20","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","00228278011","PROPRANOLOL ","120MG ER","30","Select","Select",""],["","00555097202","AMPHET\/DEXTR ","10MG","60","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","29300013510","CLONIDINE ","0.1MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","18","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00536100836","ASPIRIN ","81MG","90","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","20","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","65862001105","SERTRALINE ","25MG","14","Select","Select",""],["","27241009706","DULOXETINE ","20MG","21","Select","Select",""],["","65862037301","ESCITALOPRAM ","5MG","14","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","20","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","51991036378","RIZATRIPTAN","10MG ODT","12","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","14","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","00378018201","PROPRANOLOL","10MG","60","Select","Select",""],["","66993059502","AMPHET\/DEXTR","10MG ER","30","Select","Select",""],["","54092038301","ADDERALL","10MG","30","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","18","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","60505265401","TRAZODONE","100MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","20","Select","Select",""],["","00536100836","ASPIRIN","81MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","65862001105","SERTRALINE","25MG","14","Select","Select",""],["","27241009706","DULOXETINE","20MG","21","Select","Select",""],["","65862037301","ESCITALOPRAM","5MG","14","Select","Select",""],["","65862052790","VENLAFAXINE","37.5 ER","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}